University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
Sanford Health, North Dakota, USA.
Catheter Cardiovasc Interv. 2023 May;101(6):1161-1165. doi: 10.1002/ccd.30634. Epub 2023 Mar 15.
Invasive procedures used to manage intravascular masses such as vegetation from endocarditis, deep vein thrombosis, and septic emboli are associated with high rates of complications and mortality, especially in patients with several pre-existing comorbidities. A minimally invasive technique that has become more popular in recent years is the AngioVac procedure. This single-centered, retrospective study focuses on patient presenting comorbidities and indications for the procedure as well as postprocedural outcomes.
A total of 33 patients who underwent an AngioVac procedure at Sanford Health between March 2014 and October 2019 was reviewed. Data were collected on pre-existing comorbidities, indication of procedure, length of stay, and postoperative outcomes.
We evaluated a total of 33 patients who underwent an AngioVac procedure for removal of intravascular mass. The most common indications for the procedure were endocarditis (24/33, 73%); intracardiac mass (5/33, 15%); and deep vein thrombosis or pulmonary embolism (2/33, 6%). Post-procedural blood transfusion was required in nearly half (15/33, 45%). Almost all patients (31/33, 94%) required intraoperative vasopressor use. Nearly all patients (32/33, 97%) were directed to the intensive care unit following the procedure with an average length of stay of 8 days (interquartile range: 3-13). Most common complications seen after the procedure were shock requiring vasopressors, (13/33, 39%), pleural effusion (9/33, 27%), and sepsis (4/33, 12%). Procedural success in this single-centered experience was 85% (28/33), which was defined as size reduction of the initial vegetation by >50% in the absence of severe intraoperative complications and absence of need for further valvular surgical intervention.
For surgically high-risk patients, the AngioVac procedure may offer a less invasive option in the management of right sided endocarditis requiring vegetation debulking, intravascular thrombi or cardiac masses.
用于处理血管内肿块的有创程序，如心内膜炎、深静脉血栓形成和脓毒性栓子的赘生物，与高并发症和死亡率相关，尤其是在存在多种预先存在的合并症的患者中。近年来，一种更受欢迎的微创技术是 AngioVac 程序。这项单中心回顾性研究重点关注患者的合并症和程序适应症以及术后结果。
对 2014 年 3 月至 2019 年 10 月期间在 Sanford Health 接受 AngioVac 程序的 33 例患者进行了回顾。收集了预先存在的合并症、程序适应症、住院时间和术后结果的数据。
我们评估了 33 例接受 AngioVac 程序以清除血管内肿块的患者。该程序最常见的适应症是心内膜炎（24/33，73%）；心内肿块（5/33，15%）；和深静脉血栓形成或肺栓塞（2/33，6%）。近一半（15/33，45%）的患者需要术后输血。几乎所有患者（31/33，94%）在术中需要使用血管加压药。几乎所有患者（32/33，97%）在术后均被转入重症监护病房，平均住院时间为 8 天（四分位距：3-13）。术后最常见的并发症是需要血管加压药的休克（13/33，39%）、胸腔积液（9/33，27%）和败血症（4/33，12%）。在这一单中心经验中，程序成功率为 85%（28/33），定义为初始赘生物大小减少>50%，而无严重术中并发症且无需进一步瓣膜手术干预。
对于手术风险高的患者，AngioVac 程序可能是一种更微创的选择，用于管理需要赘生物清除、血管内血栓或心脏肿块的右侧心内膜炎。
